Mid-Season Estimates of Influenza Vaccine Effectiveness against Influenza A(H3N2) Hospitalization in the Elderly in Quebec, Canada, January 2015.
Identifieur interne : 000196 ( Main/Exploration ); précédent : 000195; suivant : 000197Mid-Season Estimates of Influenza Vaccine Effectiveness against Influenza A(H3N2) Hospitalization in the Elderly in Quebec, Canada, January 2015.
Auteurs : Rodica Gilca [Canada] ; Danuta M. Skowronski [Canada] ; Monique Douville-Fradet [Canada] ; Rachid Amini [Canada] ; Nicole Boulianne [Canada] ; Isabelle Rouleau [Canada] ; Christine Martineau [Canada] ; Hugues Charest [Canada] ; Gaston De Serres [Canada]Source :
- PloS one [ 1932-6203 ] ; 2015.
Descripteurs français
- KwdFr :
- Femelle, Grippe humaine (), Grippe humaine (immunologie), Grippe humaine (virologie), Hospitalisation (), Humains, Mâle, Nez (virologie), Québec (épidémiologie), Sous-type H3N2 du virus de la grippe A (génétique), Sous-type H3N2 du virus de la grippe A (immunologie), Sujet âgé, Sujet âgé de 80 ans ou plus, Surveillance sentinelle, Vaccins antigrippaux (usage thérapeutique).
- MESH :
- génétique : Sous-type H3N2 du virus de la grippe A.
- immunologie : Grippe humaine, Sous-type H3N2 du virus de la grippe A.
- usage thérapeutique : Vaccins antigrippaux.
- virologie : Grippe humaine, Nez.
- épidémiologie : Québec.
- Femelle, Grippe humaine, Hospitalisation, Humains, Mâle, Sujet âgé, Sujet âgé de 80 ans ou plus, Surveillance sentinelle.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Female, Hospitalization (statistics & numerical data), Humans, Influenza A Virus, H3N2 Subtype (genetics), Influenza A Virus, H3N2 Subtype (immunology), Influenza Vaccines (therapeutic use), Influenza, Human (immunology), Influenza, Human (prevention & control), Influenza, Human (virology), Male, Nose (virology), Quebec (epidemiology), Sentinel Surveillance.
- MESH :
- chemical , therapeutic use : Influenza Vaccines.
- geographic , epidemiology : Quebec.
- genetics : Influenza A Virus, H3N2 Subtype.
- immunology : Influenza A Virus, H3N2 Subtype, Influenza, Human.
- prevention & control : Influenza, Human.
- statistics & numerical data : Hospitalization.
- virology : Influenza, Human, Nose.
- Aged, Aged, 80 and over, Female, Humans, Male, Sentinel Surveillance.
Abstract
BACKGROUND
The 2014/15 influenza season in Canada was characterized by an early epidemic due to vaccine-mismatched influenza A(H3N2) viruses, disproportionately affecting elderly individuals ≥65-years-old. We assessed vaccine effectiveness (VE) against A(H3N2) hospitalization among elderly individuals during the peak weeks of the 2014/15 epidemic in Quebec, Canada.
METHODS
Nasal specimens and clinical/epidemiological data were collected within 7 days of illness onset from elderly patients admitted with respiratory symptoms to one of four participating hospitals between November 30, 2014 and January 13, 2015. Cases tested RT-PCR positive for influenza A(H3N2) and controls tested negative for any influenza. VE was assessed by test-negative case-control design.
RESULTS
There were 314 participants including 186 cases (62% vaccinated) and 128 controls (59% vaccinated) included in primary VE analysis. Median age was 81.5 years, two-thirds were admitted from the community and 91% had underlying comorbidity. Crude VE against A(H3N2) hospitalization was -17% (95%CI: -86% to 26%), decreasing to -23% (95%CI: -99 to 23%) with adjustment for age and comorbidity, and to -39% (95%CI: -142 to 20%) with additional adjustment for specimen collection interval, calendar time, type of residence and hospital. In sensitivity analyses, VE estimates were improved toward the null with restriction to participants admitted from the community (-2%; 95%CI: -105 to 49%) or with specimen collection ≤4 days since illness onset (- 8%; 95%CI: -104 to 43%) but further from the null with restriction to participants with comorbidity (-51%; 95%CI: -169 to 15%).
CONCLUSION
The 2014/15 mismatched influenza vaccine provided elderly patients with no cross-protection against hospitalization with the A(H3N2) epidemic strain, reinforcing the need for adjunct protective measures among high-risk individuals and improved vaccine options.
DOI: 10.1371/journal.pone.0132195
PubMed: 26200655
Affiliations:
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CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2015">2015</date><idno type="RBID">pubmed:26200655</idno><idno type="pmid">26200655</idno><idno type="doi">10.1371/journal.pone.0132195</idno><idno type="wicri:Area/Main/Corpus">000198</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000198</idno><idno type="wicri:Area/Main/Curation">000198</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000198</idno><idno type="wicri:Area/Main/Exploration">000198</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Mid-Season Estimates of Influenza Vaccine Effectiveness against Influenza A(H3N2) Hospitalization in the Elderly in Quebec, Canada, January 2015.</title><author><name sortKey="Gilca, Rodica" sort="Gilca, Rodica" uniqKey="Gilca R" first="Rodica" last="Gilca">Rodica Gilca</name><affiliation wicri:level="1"><nlm:affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Skowronski, Danuta M" sort="Skowronski, Danuta M" uniqKey="Skowronski D" first="Danuta M" last="Skowronski">Danuta M. Skowronski</name><affiliation wicri:level="1"><nlm:affiliation>Influenza & Emerging Respiratory Pathogens, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Influenza & Emerging Respiratory Pathogens, British Columbia Centre for Disease Control, Vancouver, British Columbia</wicri:regionArea><wicri:noRegion>British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Douville Fradet, Monique" sort="Douville Fradet, Monique" uniqKey="Douville Fradet M" first="Monique" last="Douville-Fradet">Monique Douville-Fradet</name><affiliation wicri:level="1"><nlm:affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Amini, Rachid" sort="Amini, Rachid" uniqKey="Amini R" first="Rachid" last="Amini">Rachid Amini</name><affiliation wicri:level="1"><nlm:affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Boulianne, Nicole" sort="Boulianne, Nicole" uniqKey="Boulianne N" first="Nicole" last="Boulianne">Nicole Boulianne</name><affiliation wicri:level="1"><nlm:affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Rouleau, Isabelle" sort="Rouleau, Isabelle" uniqKey="Rouleau I" first="Isabelle" last="Rouleau">Isabelle Rouleau</name><affiliation wicri:level="1"><nlm:affiliation>Bureau de surveillance et de vigie, Ministère de la Santé et des Services sociaux du Québec, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Bureau de surveillance et de vigie, Ministère de la Santé et des Services sociaux du Québec, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author><author><name sortKey="Martineau, Christine" sort="Martineau, Christine" uniqKey="Martineau C" first="Christine" last="Martineau">Christine Martineau</name><affiliation wicri:level="3"><nlm:affiliation>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal</wicri:regionArea><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Charest, Hugues" sort="Charest, Hugues" uniqKey="Charest H" first="Hugues" last="Charest">Hugues Charest</name><affiliation wicri:level="3"><nlm:affiliation>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal</wicri:regionArea><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="De Serres, Gaston" sort="De Serres, Gaston" uniqKey="De Serres G" first="Gaston" last="De Serres">Gaston De Serres</name><affiliation wicri:level="1"><nlm:affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC</wicri:regionArea><wicri:noRegion>QC</wicri:noRegion></affiliation></author></analytic><series><title level="j">PloS one</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Hospitalization (statistics & numerical data)</term><term>Humans</term><term>Influenza A Virus, H3N2 Subtype (genetics)</term><term>Influenza A Virus, H3N2 Subtype (immunology)</term><term>Influenza Vaccines (therapeutic use)</term><term>Influenza, Human (immunology)</term><term>Influenza, Human (prevention & control)</term><term>Influenza, Human (virology)</term><term>Male</term><term>Nose (virology)</term><term>Quebec (epidemiology)</term><term>Sentinel Surveillance</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Femelle</term><term>Grippe humaine ()</term><term>Grippe humaine (immunologie)</term><term>Grippe humaine (virologie)</term><term>Hospitalisation ()</term><term>Humains</term><term>Mâle</term><term>Nez (virologie)</term><term>Québec (épidémiologie)</term><term>Sous-type H3N2 du virus de la grippe A (génétique)</term><term>Sous-type H3N2 du virus de la grippe A (immunologie)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Surveillance sentinelle</term><term>Vaccins antigrippaux (usage thérapeutique)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Influenza Vaccines</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Quebec</term></keywords><keywords scheme="MESH" qualifier="genetics" xml:lang="en"><term>Influenza A Virus, H3N2 Subtype</term></keywords><keywords scheme="MESH" qualifier="génétique" xml:lang="fr"><term>Sous-type H3N2 du virus de la grippe A</term></keywords><keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Grippe humaine</term><term>Sous-type H3N2 du virus de la grippe A</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Influenza A Virus, H3N2 Subtype</term><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Hospitalization</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Vaccins antigrippaux</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Grippe humaine</term><term>Nez</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Influenza, Human</term><term>Nose</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Québec</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Male</term><term>Sentinel Surveillance</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Femelle</term><term>Grippe humaine</term><term>Hospitalisation</term><term>Humains</term><term>Mâle</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Surveillance sentinelle</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The 2014/15 influenza season in Canada was characterized by an early epidemic due to vaccine-mismatched influenza A(H3N2) viruses, disproportionately affecting elderly individuals ≥65-years-old. We assessed vaccine effectiveness (VE) against A(H3N2) hospitalization among elderly individuals during the peak weeks of the 2014/15 epidemic in Quebec, Canada.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Nasal specimens and clinical/epidemiological data were collected within 7 days of illness onset from elderly patients admitted with respiratory symptoms to one of four participating hospitals between November 30, 2014 and January 13, 2015. Cases tested RT-PCR positive for influenza A(H3N2) and controls tested negative for any influenza. VE was assessed by test-negative case-control design.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>There were 314 participants including 186 cases (62% vaccinated) and 128 controls (59% vaccinated) included in primary VE analysis. Median age was 81.5 years, two-thirds were admitted from the community and 91% had underlying comorbidity. Crude VE against A(H3N2) hospitalization was -17% (95%CI: -86% to 26%), decreasing to -23% (95%CI: -99 to 23%) with adjustment for age and comorbidity, and to -39% (95%CI: -142 to 20%) with additional adjustment for specimen collection interval, calendar time, type of residence and hospital. In sensitivity analyses, VE estimates were improved toward the null with restriction to participants admitted from the community (-2%; 95%CI: -105 to 49%) or with specimen collection ≤4 days since illness onset (- 8%; 95%CI: -104 to 43%) but further from the null with restriction to participants with comorbidity (-51%; 95%CI: -169 to 15%).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The 2014/15 mismatched influenza vaccine provided elderly patients with no cross-protection against hospitalization with the A(H3N2) epidemic strain, reinforcing the need for adjunct protective measures among high-risk individuals and improved vaccine options.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">26200655</PMID><DateCompleted><Year>2016</Year><Month>05</Month><Day>01</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>06</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN><JournalIssue CitedMedium="Internet"><Volume>10</Volume><Issue>7</Issue><PubDate><Year>2015</Year></PubDate></JournalIssue><Title>PloS one</Title><ISOAbbreviation>PLoS ONE</ISOAbbreviation></Journal><ArticleTitle>Mid-Season Estimates of Influenza Vaccine Effectiveness against Influenza A(H3N2) Hospitalization in the Elderly in Quebec, Canada, January 2015.</ArticleTitle><Pagination><MedlinePgn>e0132195</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0132195</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The 2014/15 influenza season in Canada was characterized by an early epidemic due to vaccine-mismatched influenza A(H3N2) viruses, disproportionately affecting elderly individuals ≥65-years-old. We assessed vaccine effectiveness (VE) against A(H3N2) hospitalization among elderly individuals during the peak weeks of the 2014/15 epidemic in Quebec, Canada.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Nasal specimens and clinical/epidemiological data were collected within 7 days of illness onset from elderly patients admitted with respiratory symptoms to one of four participating hospitals between November 30, 2014 and January 13, 2015. Cases tested RT-PCR positive for influenza A(H3N2) and controls tested negative for any influenza. VE was assessed by test-negative case-control design.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">There were 314 participants including 186 cases (62% vaccinated) and 128 controls (59% vaccinated) included in primary VE analysis. Median age was 81.5 years, two-thirds were admitted from the community and 91% had underlying comorbidity. Crude VE against A(H3N2) hospitalization was -17% (95%CI: -86% to 26%), decreasing to -23% (95%CI: -99 to 23%) with adjustment for age and comorbidity, and to -39% (95%CI: -142 to 20%) with additional adjustment for specimen collection interval, calendar time, type of residence and hospital. In sensitivity analyses, VE estimates were improved toward the null with restriction to participants admitted from the community (-2%; 95%CI: -105 to 49%) or with specimen collection ≤4 days since illness onset (- 8%; 95%CI: -104 to 43%) but further from the null with restriction to participants with comorbidity (-51%; 95%CI: -169 to 15%).</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">The 2014/15 mismatched influenza vaccine provided elderly patients with no cross-protection against hospitalization with the A(H3N2) epidemic strain, reinforcing the need for adjunct protective measures among high-risk individuals and improved vaccine options.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gilca</LastName><ForeName>Rodica</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Skowronski</LastName><ForeName>Danuta M</ForeName><Initials>DM</Initials><AffiliationInfo><Affiliation>Influenza & Emerging Respiratory Pathogens, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Douville-Fradet</LastName><ForeName>Monique</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Amini</LastName><ForeName>Rachid</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Boulianne</LastName><ForeName>Nicole</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rouleau</LastName><ForeName>Isabelle</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Bureau de surveillance et de vigie, Ministère de la Santé et des Services sociaux du Québec, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Martineau</LastName><ForeName>Christine</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Charest</LastName><ForeName>Hugues</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>De Serres</LastName><ForeName>Gaston</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada; CHU de Quebec, Quebec, QC, Canada; Laval University, Quebec, QC, Canada.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>07</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>United 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uniqKey="De Serres G" first="Gaston" last="De Serres">Gaston De Serres</name><name sortKey="Douville Fradet, Monique" sort="Douville Fradet, Monique" uniqKey="Douville Fradet M" first="Monique" last="Douville-Fradet">Monique Douville-Fradet</name><name sortKey="Martineau, Christine" sort="Martineau, Christine" uniqKey="Martineau C" first="Christine" last="Martineau">Christine Martineau</name><name sortKey="Rouleau, Isabelle" sort="Rouleau, Isabelle" uniqKey="Rouleau I" first="Isabelle" last="Rouleau">Isabelle Rouleau</name><name sortKey="Skowronski, Danuta M" sort="Skowronski, Danuta M" uniqKey="Skowronski D" first="Danuta M" last="Skowronski">Danuta M. 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